Provider Demographics
NPI:1306829841
Name:HANDKE, DARREL DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREL
Middle Name:DEAN
Last Name:HANDKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 6TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4517
Mailing Address - Country:US
Mailing Address - Phone:775-329-9010
Mailing Address - Fax:775-329-4899
Practice Address - Street 1:236 W 6TH ST
Practice Address - Street 2:STE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4517
Practice Address - Country:US
Practice Address - Phone:775-329-9010
Practice Address - Fax:775-329-4899
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3985207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016972Medicaid
C96353Medicare UPIN
NV002016972Medicaid